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Type 2 Adjust Metformin Dose based on meal portions?

Discussion in 'Ask A Question' started by tan800, Mar 15, 2017.

  1. tan800

    tan800 Type 2 · Active Member

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    I would like to seek your suggestions if it's better to take my daily metformin, 1000mg total, based on how many meals I have per day, also take into account on light/heavy meal, etc.

    My recent H1bAc was too high, > 10, so I would like to be very careful on my BG level, and want to make sure to take my metformin in right ways.

    Mostly I have two meals per day, so I took 500mg for each meal, then if I have three meals per day, how should I take the 1000mg?

    Or if I have a big meal for lunch, should I take 750mg?

    Thanks in advance for sharing your experiences.
     
  2. Pipp

    Pipp Type 2 · Expert
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    Hello @tan800

    Have you been prescribed two metformin a day? Are they the 500mg per tablet?
    I don't see how you could split the tablets. So would go with the prescribed amount. What does the prescription label advise?

    I know, I ask too many questions. Just trying to get a clearer idea of what is going on.

    What else are you doing to improve your HbA1c? What foods are you eating, and are you testing your own blood glucose to gauge the effect of your diet?
     
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  3. lovinglife

    lovinglife Type 2 · Well-Known Member

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    metformin doesn't work like that, it's a build up drug so taking it with a big meal won't make a difference. Met isn't that effective on lowering numbers but does help insulin resistance - just keep taking them as you have been doing - as long as they are evenly spread. I'm on same dose as yourself and I take 1x500g with my breakfast and same with my evening meal :)

    What else are you trying to reduce your numbers? Have you considered lowering your carbs, many of us find significantly reducing our carb consumption is the most effective way of lowering our blood sugar. Have you had the welcome info from @daisy1 - it's a good place to start and have a look around the low carb forum
     
  4. tan800

    tan800 Type 2 · Active Member

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    I was prescribed 500mg x 2 per day, because most of the time I have two meals daily, so doctors told me take 500mg before meal. There are 250mg x 2 for the 500mg tablet.

    For a few months I was trying to reduce my carb, seems BS was ok, so I stopped metformin for a month, then found my HbA1c was very high, then I backed to metformin to get BS level under control.

    I am new to the forum and would like to learn as much as I can, especially I realised that people here watched BS level so closely, I really like to learn from you all.

    ps. diagnosed T2 almost 20 years ago, metformin 1g to 1.5g, weight loss to date 150lb
     
  5. tan800

    tan800 Type 2 · Active Member

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    I tried to reduce my carbs, also maintain daily excise, 1- 1.5 hour. Seems my high HbA1c was due to my mistake that I stopped my metformin altogether instead of gradually reducing my metformin dose.

    btw, you would not take met before lunch?
     
  6. walnut_face

    walnut_face Type 2 · Well-Known Member

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    @tan800 you should take them as directed by your HCP, having said that DO read the information leaflet, as there are occasions when you should not take them. As @Lovinlife states their contribution to reducing BS is minimal, there are other things you can try/do that have a greater impact
     
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  7. Brunneria

    Brunneria Other · Guru
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    Hi and welcome!

    Congratulations on the weight loss! 150 pounds is amazing. Well done!

    (I agree with everyone else that you should be taking the tablets as prescribed).
     
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  8. Daibell

    Daibell LADA · Master

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    Hi. Yes, Metformin works over time so doesn't need to be matched to meals whereas some other meds such as Gliclazide do relate to meals.
     
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  9. Pipp

    Pipp Type 2 · Expert
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    Impressive weight loss, @tan800. Almost 20 years since diagnosis, you have been managing well, but you are right, you need to lower the blood glucose. Were you given a meter when you were first diagnosed? I was in 2005, then the rules changed. I fund my own testing now, as that is the way to know and understand how foods affect blood glucose.

    You have already mentioned reducing carb, and how that improved things for you. What about doing that again, and taking the Metformin as prescribed. Record blood testing results for yourself, and record what you are eating. The Low carb programme in here might be what you are looking for.

    Also, not sure if you have seen the info already, but @daisy1 will post the useful advice when she sees she has been tagged here.
     
  10. daisy1

    daisy1 Type 2 · Legend

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    @tan800

    Hello and welcome to the Forum :) As mentioned above, here is the Basic Information we give to new members and I hope you will find it useful. Ask more questions when you need to and someone will help.


    BASIC INFORMATION FOR NEW MEMBERS

    Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

    A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 147,000 people who are demonstrating this.

    On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

    The role of carbohydrate

    Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

    If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

    The bad news

    Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

    The good news

    People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

    Controlling your carbs

    The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

    There are two approaches to controlling your carbs:
    • Reduce your carbohydrate intake
    • Choose ‘better’ carbohydrates
    Reduce your carbohydrates

    A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

    The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

    Choosing better carbohydrates

    The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

    Read more on carbohydrates and diabetes.

    Over 145,000 people have taken part in the Low Carb Program - a free 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

    Eating what works for you

    Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

    To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

    The blood sugar ranges recommended by NICE are as follows:

    Blood glucose ranges for type 2 diabetes
    • Before meals: 4 to 7 mmol/l
    • 2 hours after meals: under 8.5 mmol/l
    Blood glucose ranges for type 1 diabetes (adults)
    • Before meals: 4 to 7 mmol/l
    • 2 hours after meals: under 9 mmol/l
    Blood glucose ranges for type 1 diabetes (children)
    • Before meals: 4 to 8 mmol/l
    • 2 hours after meals: under 10 mmol/l
    However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

    Access to blood glucose test strips

    The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

    • structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
    • self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

    Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

    You may also be interested to read questions to ask at a diabetic clinic.

    Note: This post has been edited from Sue/Ken's post to include up to date information.

    Take part in Diabetes.co.uk digital education programs and improve your understanding. They're all free.
    • Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why :)
    • Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
     
  11. tan800

    tan800 Type 2 · Active Member

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    Thanks for your great welcome post, very helpful. I had read low carb program 1 year ago, and started to reduce my carb daily, also tried to reverse my diabetes. Somehow I had problems to maintain my BG level, so will try to be more careful about BG level, metformin dose.
     
    • Winner Winner x 1
  12. Pipp

    Pipp Type 2 · Expert
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    @tan800
    Great that you read the low carb programme, but have you tried following the step by step course? It is a gradual, weekly, programme of progressive change.
     
  13. Pinkorchid

    Pinkorchid Type 2 · Well-Known Member

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    I think your weight loss and the fact that you have been T2 for 20 years and still only on Metformin with presumably no serious complications is awesome. Your BG level at 10 is not really very high but could do with coming down a bit. You say you have reduced your carbs which is good and you exercise well so I would say just take the Metformin as prescribed and I am sure you will go on doing well and your BG will come down
     
  14. Pipp

    Pipp Type 2 · Expert
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    Sorry, @Pinkorchid , I can't agree. I would be doing more to reduce HbA1c with a level of more than 10 as @tan800 has mentioned. Also, not sure which measurement indicator tan800 is using. Could mean 10% or 10mmol/L. Either would not be good.
    Twenty years post diagnosis and only on Metformin does indeed suggest previously well managed T2, and the weight loss will have helped, but as we age, diabetes management needs change. I would be proactive rather than passive if I saw such a rise in HbA1c as tan800 has.
     
    • Agree Agree x 2
  15. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    Hi,

    Very well done on that tremendous weight loss! That is brilliant. :)

    As the others have said, Metformin accumulates in your body and works on the liver to help a little with insulin resistance and to reduce the amount of natural glucose the liver produces, although only to a limited extent. It isn't related to your food intake at all. The only reason you are told to take it before meals is to stop you feeling sick with stomach problems.

    I also agree with @Pipp that your HbA1c is too high and needs bringing down, but you obviously know this or you wouldn't be asking for help.

    I wonder if we can help you with your food? Perhaps tell us what you typically eat in a day and we may spot something that could help.
     
  16. tan800

    tan800 Type 2 · Active Member

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    @Pipp not really following the steps, but I did reduced my carb substantially to 150g-200g/day, cut down by 50%.

    I have much to learn from you in reversal of diabetes, but I heard that it is mainly suitable for patients with 10 year or less, so I am not so sure if the low carb program can help me or not, but I am determined to find out.

    I am very keen to learn from patients with long history, and how they are practising the low carb program. Thanks

    btw, my H1A1c 10 %
     
    #16 tan800, Mar 16, 2017 at 1:12 PM
    Last edited: Mar 16, 2017
  17. Sid Bonkers

    Sid Bonkers Type 2 · Well-Known Member

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    Metformin doesnt work instantly meal by meal like fast acting insulin does, metformin works over a 24 hour period and for best results should be taken twice a day, morning and evening with food ie with breakfast and an evening meal.

    I dont suppose it makes a huge difference you taking it three times a day but it may have a worse effect on your tummy if you take it without food..

    The food acts like a barrier and I found it best to take it during a meal ie after I had eaten a few mouthfuls of food I would take my tablet/s and then continue eating. That way I avoided any cramps, nausea and upset stomach.
     
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  18. tan800

    tan800 Type 2 · Active Member

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    @bluetit thanks for your encouragement :)

    My last HbA1c was too high, it was because I stopped my metformin without monitoring my BG level for a few months:(.

    I reduced my carb to 150-200g daily( bread, rice or noodle), 2 -3 mid size fruits, like banana/orange, moderate amount of meat such as fish, beef or pork, and moderate amount of veg, 1 -2 fried eggs, 1-2 glasses of milk, 80 - 100 g peanut butter, etc. I don't eat much sugar, no ice cream, no cake, no soft drinks,
    no coke since diagnosed.

    Roughly my daily carolies are around 1500 - 1800. BTW, I have never been overweighting, BMI 21, was 25 a few years ago.

    I did not test my BG level for different food, not very sure how to do it unless for a meal I only take one kind of food, even then not sure how much I should eat to make sense. Also not sure if I need to the testing without taking metformin or not.
    Hopefully with the helps from you and many others of this forum I can be successful in reversal of my diabetes.
     
    #18 tan800, Mar 16, 2017 at 1:35 PM
    Last edited: Mar 16, 2017
  19. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    You test immediately before you eat your meal. Then you test again 2 hours after your first bite. Look at the rise from before to after. The only items in that meal that will have caused that rise are the carbs. The fats and proteins don't do this. Keep a food diary including portion sizes and record your levels alongside. You will soon see patterns emerging and be able to seriously reduce the carb elements or eliminate some completely.

    At the risk of sounding very harsh, 150g carbs is the maximum amount to be considered low carb, and is a very difficult amount for our bodies to cope with. I suggest your high levels are due to bread, rice, noodles, bananas and oranges, plus milk. All these are very high in sugar and carbs. If you cut out those particular carbs and stick to meat, fish, salads, vegetables (not root veg) and fats your levels will improve. Have a look at this https://www.dietdoctor.com/low-carb/60-seconds which gives lists of good foods and foods to avoid. You will find it useful.
     
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  20. tan800

    tan800 Type 2 · Active Member

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    @bluetit thanks for explaining how to do food testing with BG level, hopefully I will see patterns emerging:)

    As I mentioned I did not follow the low carb program, this is because no need to lose weight for me, my objectives are
    1. make my BG level normal without taking metformin, but with right diet and excise;
    2. reverse my diabetes of 20 years;

    I will do my testing and hopefully find out what food can cause high BG, then see if I need to cut down daily carb to under 100g. BTW, in doing so should I not change my metformin dose in the beginning?

    Thanks again for your great help.
     
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